According to a recent national survey conducted by Cleveland Clinic, 32 percent of men are concerned about their sexual health as they get older. Yet about one third of the concerned men say they have never been screened for prostate cancer (33 percent), bladder cancer (36 percent) or testicular cancer (37 percent).
“Prostate cancer is very common, affecting about 1 in 7 men,” said Dr. Jamil Syed, a urologist with Cleveland Clinic Indian River Hospital. “Apart from skin cancer, prostate cancer is the most common cancer in American men and early detection is the key to the cure.”
The good news is that prostate cancer has a 98 percent cure rate when diagnosed in the early stages. That’s why regular screening is so important. Screening is based on age and family history. Having a father or brother with the disease more than doubles a man’s risk of developing the disease. Men with a family history of the disease should start having discussions about screening with their primary care physician or urologist around the age of 40. For those at average risk, that decision on whether or not to get a PSA screening test should be discussed by the age of 55.
The prostate is a gland found only in males and it makes fluid that is part of the semen. In younger men the prostate is about the size of a walnut, but it grows much larger as a man ages.
Prostate cancer is more likely to develop in older men and in non-Hispanic Black men. Most cases are diagnosed in men who are 65 or older and it’s a rare condition in men under 40.
Prostate cancer can often be found early by testing for prostate specific antigen (PSA) levels in a man’s blood. A high PSA level indicates an increased risk of having the disease. If the result of a PSA screening is abnormal, you will probably need a biopsy know whether you have cancer.
The American Cancer Society defines PSA (prostate-specific antigen) as a protein made by cells in the prostate gland, and while it’s mostly found in semen, a small amount is also found in the blood. The PSA level is measured in units called nanograms per milliliter (ng/mL). The chances of having prostate cancer goes up as the PSA level goes up, but there is no set cutoff point when deciding if a man might need further testing. Most men without prostate cancer have PSA levels under 4ng/mL. Men with a PSA level between 4 and 10 are called borderline and have a 1 in 4 chance of having prostate cancer. If the PSA is more than 10, the chance of having prostate cancer is over 50 percent.
“It’s important to note that patients with a larger size prostate often have a higher PSA level even though they don’t have prostate cancer,” Dr. Syed noted. “As you age so does the likelihood that you have benign enlargement. Tumors can also influence how high your PSA is, so it’s important to take the size of the prostate into consideration. You also have to look at the trend of the PSA level as well.”
If prostate cancer is suspected based on the screening, more testing will be needed to be sure.
The actual diagnosis of prostate cancer can only be made with a prostate biopsy.
“Most people who get diagnosed with prostate cancer these days because of the screenings are asymptomatic,” Dr. Syed explained, which is a big plus. “If you do develop symptoms, it usually indicates that it’s a more advanced type of disease. In those scenarios you might see blood in the urine, lower abdominal pain when urinating and changes in urinary habits.
“It doesn’t always need to be treated either. Treatment is dependent on the type of tumor and the patient’s characteristics like age and any comorbidity, and what their preference of treatment is. Most men choose some form of treatment. It can be done with surveillance and testing routinely or with more active treatments that include surgery or radiation.”
About 85 percent to 90 percent of prostate cancer that is detected initially is localized to the prostate and the surrounding area of the prostate. Only about 10 percent of prostate cancers spread outside the prostate to the bone, lymph nodes, liver or lungs.
There are many drugs and procedures available to treat prostate cancer, with more being studied and introduced all the time. Local treatments like surgery and radiation therapy are used to treat a specific tumor. Drug treatments like chemotherapy, immunotherapy and hormone therapy are also common treatments.
“If someone comes to us with localized prostate cancer, meaning that it has not spread to other parts of the body, surgery is the option most people choose,” Dr. Syed said. “We have procedures that do not require taking out the entire prostate. We have ablation methods where we can use electrical or thermal energy to treat the cancer. And for advanced prostate cancer patients, we have androgen deprivation therapy that reduces testosterone levels. Discussing the options with your doctor will help you decide which treatment is best for you.”
Circling back to the concern of losing sexual function – which can be impacted by prostate cancer treatments – Dr. Syed acknowledges that sexual function is important to a man’s quality of life.
“Men younger than 55 have a higher ability to regain erectile functions after treatment than older men. It depends on where you are before the surgery and what type of surgery you have.
Based on the tumor characteristics, some patients are candidates for a nerve sparing prostatectomy to preserve their erectile function. There are also medications like Viagra that can help restore sexual function. A discussion with your doctor will answer all your questions and concerns about sexual function.”
The takeaway is to start a conversation with your doctor about screening and get all of your questions answered. Remember that early detection of prostate cancer is the key to survival, so get screened and treated if necessary and enjoy the rest of your life.
Dr. Jamil Syed completed his medical education at the University of Florida College of Medicine in Gainesville and his internship in surgery and residency in urology at Yale New Haven Hospital in New Haven, Conn. His office is located in the Health & Wellness Center at Cleveland Clinic Indian River Hospital, 3450 11th Court, Vero Beach. Call 772-794-9771 for an appointment.
